For a number of decades in the United States, this phrase simply finished out a traditional good night well-wish rhyme with no practical meaning. However, due to increased international travel and resistance to insecticides, the little creatures have experienced a resurgence and are being found increasingly in private homes, five star hotels and even hospitals.

“Health care environments are susceptible to bed bugs because people typically take their personal items to places where they will stay, like psychiatric wards, maternity wards and emergency rooms,” noted Ronald Harrison, PhD, entomologist and technical services director at Orkin, LLC. “Waiting rooms are also susceptible because those tend to be heavy traffic areas, and bed bugs can very easily make their way from someone’s belongings to a wheelchair or couch, chair or other waiting room accommodations.”

To prevent infestations, it is recommended that waiting room furniture have hard surfaces and no fabric elements, although this can obviously affect comfort for patients and visitors.

Ronald Harrison, PhD, entomologist, says it is well worth the effort for hospitals to take preventive measures against bed bugs.

Health care professionals who enter patients’ homes, such as emergency medical technicians (EMTs), home health nurses and aides, and public health providers, need to be especially cautious.

“Ambulance personnel are going directly into someone’s home and collecting things that may be infested,” remarked Harrison. “Nurses who enter a patient’s home should not put their bag down anywhere inside the home. Bed bugs can be easily transported to another home or to the nurse’s home that way. Also, it’s important to think about equipment that is taken into people’s homes, as bed bugs can make their way onto equipment and be transported to a new location.”

Although having bed bugs may carry a certain stigma, their presence is not determined by the cleanliness of the living conditions where they are found.

“Bed bug infestations usually occur around or near areas where people sleep. The risk of encountering bed bugs increases if you spend time in places with high turnovers of nighttime guests--such as hotels or hospitals. They hide during the day in places like seams of mattresses, box springs, bed frames, headboards, dresser tables, inside cracks or crevices, behind wallpaper, or any other clutter or objects around a bed,” explained Betsy Hackman, RN, CIC, director of infection prevention for Emory Healthcare in Atlanta, Ga.

In order to prevent an infestation, Harrison suggests that hospitals have a good inspection routine.

“Hospital staff needs to stay alert, and they need to be aware of and educated about bed bugs. It is well worth their time to take proper precautions,” he said. “Hospitals should proactively do treatments. Pest control professionals can place residual products to help prevent bed bug infestations. There are also a variety of monitoring programs that can be put in place, and hospitals can also receive bed bug dog inspections.”

Health care staff should also be cautious to not take bed bugs home. It is always wise to change out of work clothes as soon as you get home and immediately wash your clothes in hot water and dry them on the highest heat setting.

“One of the easiest ways to identify a bed bug infestation is by the bite marks on the face, neck, arms, hands or any other body parts incurred while sleeping,” added Hackman. “However, these bite marks may take as long as 14 days to develop in some people, so it is important to look for other clues when determining if bed bugs have infected an area.”

Look for these signs of an infestation:

1. Bed bugs’ exoskeletons after molting;

2. Bed bugs in the fold of mattresses or sheets;

3. Rusty-colored blood spots due to the blood-filled fecal material that they excrete on the mattress or furniture;

4. A sweet, musty odor.

If you suspect that you have found a bed bug, try to trap the bug for an exterminator to evaluate, as there are other bugs that look like bed bugs. Once the bug has been identified, the next step is to determine if it was recently introduced or if there is an infestation. In an infestation there are bed bugs at all life stages--eggs, nymphs and adults. Finally, contact an experienced bed bug treatment company to determine the appropriate course of action.

“When it comes to removing bed bugs from a health care environment, there are a variety of treatment options, but one has to be careful,” Harrison stated. “Orkin does not perform treatments where there are people, so patients have to be moved. Most hospital beds are portable, so they can be removed to be treated. All other room equipment must be treated efficiently, either with products or heat.”

“Bed bug bites do not usually pose a serious medical threat and should not be considered a medical or public health emergency,” noted Hackman. “Though their bites may cause itching and loss of sleep, bed bugs are not known to spread disease. Sometimes the itching can lead to excessive scratching that can increase the chance of a secondary skin infection. The best way to treat a bite is to avoid scratching the area and apply antiseptic creams or lotions and take an antihistamine.”